Background/Aims: Endoscopic submucosal dissection (ESD) for superficial non-ampullary duodenal epithelial tumors (SNADETs) is technically challenging and is associated with a risk of adverse events, particularly when lesions are located near the major papilla. Pancreatic duct (PD) stent may reduce the risk of post-ESD pancreatitis; however, no standard strategy has been established. This study aimed to evaluate the effectiveness and safety of PD stent placement combined with ESD for SNADETs near the major papilla. Methods: This was a retrospective study of duodenal ESD after prophylactic PD stent placement in patients with SNADET near the major papilla at a university hospital between March 2014 and September 2023. Results: Four lesions were located within 5 mm of the major papilla, and seven within 5 to 10 mm. The median interval between stent placement and ESD was 2 days. The en bloc and R0 resection rates were 100% and 90.9%, respectively. No stent migration occurred during ESD, and all mucosal defects were completely closed using endoscopic clips. Delayed bleeding and post-ESD pancreatitis were observed in one and two cases, respectively. Conclusions PD stent placement combined with ESD is an effective treatment strategy for SNADETs near the major papilla. However, the risk of post-ESD pancreatitis remains, indicating the need for further preventive strategies.

It is common knowledge that exposure to asbestos causes asbestos-related diseases, such as asbestosis, lung cancer and malignant mesothelioma, not only in people who have had long-term contact with asbestos in their work environment but also in residents living near factories that handle asbestos. Since the summer of 2005, these revelations turned into a large medical problem and caused and social unrest. We have focused on the immunological effects of both asbestos and silica on the human immune system. In this brief review, we introduce immunological alterations found in patients with malignant mesothelioma and describe the experimental background in which these were found. Analyzing the immunological effects of asbestos may improve our understanding of the biological effects of asbestos.

An 80-year-old woman who had been suffering from atrial fibrillation and recurrent cerebral infarction was admitted to our hospital. Transesophageal echocardiography revealed a giant mobile thrombus in the left atrial appendage. The patient underwent thrombectomy and left atrial appendage obliteration under cardiopulmonary bypass. Her postoperative course was uneventful. The patient showed no recurrence of the left atrial thrombus nor thromboenbolism postoperatively. Based on the present results, we recommend cardiac thrombus be investigated by transesophageal echocardiography in cases of atrial fibrillation accompanied by recurrent thromboembolism. This should be followed by thrombectomy under cardiopulmonary bypass, even in the elderly.

A study was conducted to determine the accuracy of body composition prediction equations using the bioelectrical impedance (BI) method and skinfold thickness (ST) method for predicting longitudinal alterations in the body composition of schoolchildren. Seventeen healthy junior high school boys, aged 12 to 13 yr, participated in the study. Body density (Db) was determined by underwater weighing (UW) . Impedance was measured using a portable four-terminal impedance plethysmograph (800 μA, 50 kHz ; Selco, SIF-891) . Db values by the BI method were estimated from the equations developed for schoolchildren by Watanabe et al. (1993) and Kim et al. (1993) . Db by the ST method was estimated from the equations developed for schoolchildren by Nagamine et al. (1974) and Watanabe et al. (1993), using the sum of skinfold thickness at the triceps and subscapular area. Skinfold thickness was measured on the right side of the body with an Eiken-type skinfold caliper. The changes in Db and body fat measured by UW were small every year. The fat free mass (FFM) measured by UW increased significantly every year. The body composition (average Db, body fat and FFM) values estimated by the BI and ST methods showed no significant differences against average UW values. However, these average values estimated using the equation of Nagamine et al. (1974) were significantly different from the average UW values. The absolute amount of change in FFM (Δ FFM) estimated from BI and ST methods were correlated significantly with absolute amount of change in FFM (Δ FFM) determined by UW. In particular, the accuracy of body composition prediction equations for the BI method (r²= 0.81 for Watanabe et al., r² = 0.77 for Kim et al.) was higher than that of body composition prediction equations for the ST method (r²=0.41 for Nagamine et al., r²= 0.55 for Watanabe et al) . The findings of this study suggest that the body composition prediction equations based on the BI method are useful for valid assessment of longitudinal alterations in the body composition of schoolchildren.

The purpose of this study was to elucidate the relationship between the energy expenditure and the level of physical performance in preschool-age children. Seventy-six boys (5-6 years of age) had motor performance tests (25 m run, soft-ball throw, standing-long-jump, Zig-Zag run, upright handstand jog time, sit-and-reach, one-leg-balance) . Twenty boys were divided into two groups. One consisted of ten boys as the superior group and the other ten boys as the inferior group in results of the motor performance tests.
Energy expenditure was calculated from oxygen intake measured by each child's HR-VO₂ regression equation in a treadmill running test and 24-hour heart rate measurement by monitoring recorder. Daily energy uptake was estimated from the weight and kind of food recorded by their parents.
Energy expenditure in kindergarten, at home and in one day for the superior group were found to be higher than those for the inferior group. Energy uptake in the superior group showed a significant-ly higher value than that in the inferior group. It can be concluded that the children of the superior group appeared to be more active, since test and monitoring measurements showed they had more energy expenditure and energy uptake.

To clarify changes in body temperature during endurance exercise in patients with spinal cord injury (SCI), we measured tympanic temperature (Tty) and skin temperature in the head, arm, chest, thigh, shin and calf in 5 patients with SCI (T6-T 12) and 7 normal controls during 30 minutes arm cranking exercise (20 watts) from 10 minutes before the initiation of exercise until 10 minutes after the termination of exercise in an artificial climate room at a temperature of about 25°C with a relative humidity of about 50%. The Tty in the SCI group was lower than that in the control group from 10 minutes before the initiation of exercise to 10 minutes after the termination of exercise with a significant difference only at the initiation of exercise. The difference in Tty slightly decreased with continuation of exercise. The Tty in the SCI group at rest was 36.05-37.15°C. Four patients in this group showed a decrease of 0.04-0.12°C in the early stage and an increase of 0.66°C±0.19 (mean±SD) at the end of exercise over the value at the initiation of exercise.
The skin temperature was lower in the SCI group than in the control group in all sites excluding the arm. Significant differences were observed in the head in the early stage of exercise and after exercise, in the chest from 10 minutes before the initiation of exercise to 5 minutes after the termination of exercise, in the thigh from 10 minutes before the initiation of exercise to 10 minutes after the termination of exercise, in the shin 10 minutes and 5 minutes before the initiation of exercise, and in the calf from before to 15 minutes after the initiation of exercise. In the SCI group, marked individual differences were observed in the skin temperatures in the thigh, shin, and calf, suggesting specificity of the skin temperature response in and near the paralysis area.
Results in Tty in this study suggested no heat retention in the SCI patients. Therefore, the risk for heat disorders seems to be low during moderate or mild exercise under moderate temperature environment at a temperature of about 25°C with a relative humidity of about 50% even when the skin temperature is low, and thermolysis is not marked.

A study was conducted to clarify the influence of water immersion at different levels on pulmonary response. The subjects, ten healthy men (mean age, 26.2±7.9 years), subjected to measurement of static lung volumes and maximum expiratory flow-volume curves while sitting immersed in water at the level of both the neck and diaphragm. TLC, VC, ERV and FRC for water immersion at the diaphragm level were significantly decreased in comparison with those measured in air. These lung volumes were further decreased upon water immersion to neck level. However, RV did not change significantly upon immersion at either water level. Significant decreases of FEV_1⋅0, FEV_1⋅0%, V₅₀ and V₂₅ were observed upon water immersion at the diaphragm level as compared with those obtained in air. Water immersion to neck level produced further decreases in pulmonary functional parameters. Although peak flow and V₇₅ did not change significantly upon water immersion at either level, V₅₀ and V₂₅ were decreased markedly in comparison with the values obtained in air. A tendency for a marked decrease in pulmonary function parameters was observed upon water immersion to neck level. The changes observed upon water immersion to diaphragm level may have resulted from compression of small airways induced by both an increase of blood volume in the thorax and hydrostatic pressure against the abdomen. The changes induced by water immersion to neck level may have been exacerbated by the two mechanisms described above, in addition to hydrostatic pressure on the chest wall. The present results suggest that the significant reduction of pulmonary functional parameters caused by water immersion may be due to compression of small airways induced by an increase of blood volume in the thorax and hydrostatic pressure on the chest wall and abdomen.

A study was conducted to investigate the validity of skinfold-based prediction equations for body density (Db, g/ml) developed by Nagamine et al. (1974), and to formulate convenient, useful equations for predicting Db by the skinfold thickness (ST) method in junior high school boys and girls. The subjects of the study were 269 healthy boys and girls, aged 12-15 years. The dependent variable, Db, was determined by underwater weighing (UW) . Independent variables included single skinfold thickness at three sites (triceps, subscapular and abdomen) and the sum of two skinfolds. Db by the ST method was estimated from the equations developed by Nagamine et al. (1974) for boys and girls, using the sum of skinfold thickness at the triceps and subscapular area. Skinfold thickness was measured on the right side of the body with an Eiken-type skinfold caliper. Db estimated by the ST method was correlated significantly with Db determined by UW (r=0.873 for boys and r=0.723 for girls) . However, average Db values estimated by the ST method were significantly lower than those deter-mined by UW (differences in Db values when predicted by the Nagamine equations: 0.0099 for boys and 0, 0114 for girls) . Therefore, we developed linear regression equations for predicting Db. The best-fitting prediction equation for Db was Db=1.0881-0.0010·X for boys, and Db=1.0715-0.0007·X for girls, where X is the sum of the triceps and subscapular skinfold thickness (mm) for boys and girls. Db estimated from the respective equation was correlated significantly with hydrodensitometrically determined Db (r=0.872, SEE=0.0089 for boys; r=0.722, SEE=0.0104 for girls) .
Furthermore, in a cross-validation analysis of prediction equations for Db developed in the present study, Db estimated from the respective equation was correlated highly with hydrodensitometrically determined Db (r=0.887 for boys and r=0.740 for girls) . There were no significant differences between the Db values predicted by the ST method against hydrodensitometrically determined Db values (difference values: 0.0012 for boys and 0.0013 for girls) . The final phase of this study was to develop more stable equations, combining validation and cross-validation samples. On the basis of the final analyses, we recommend the equations Y=1.0875-0.0010X and Y=1.0716-0.0007X, with SEE of 0.0088g/ml for boys and 0.0105g/ml for girls, respectively. It is suggested that the prediction equations finally developed in the present study will be applicable to junior high school boys and girls.

The tetrapolar bioelectrical impedance (BI) method has been proposed as a convenient, valid approach for estimating the body composition of normal healthy adults. However, the validity of the BI method has not yet been confirmed for Japanese junior high school boys and girls. The purpose of this study was to develop convenient and useful equations for predicting the body composition in junior high school boys and girls by the BI method. The subjects were 297 healthy boys and girls, aged 12.15 years, all of whom were Japanese. Impedance was measured using a tetrapolar bioelectrical impedance plethysmograph (800 pA, 50 kHz SIF-891) manufactured by Selco. Multiple regression analysis was used to derive prediction equations for Db that were specifically applicable to boys and girls. The effective prediction equations for Db were as follows : 1) Db=1.1860-0.1282 (Wt·Z) /Ht², and 2) Db=1.1402-0.0706 (Wt·Z) /Ht²-0.0007· (abdomen) for boys. 1) Db=1.1337-0.0778 (Wt·Z) /Ht², and 2) Db=1.1124-0.0498 (Wt·Z) /Ht²-0.0006· (subscapular) for girls, where Db=body density (g/ml), Wt=weight (kg), Z =impedance (ohms), Ht=height (cm) . Db estimated by each respective equation was highly correlated with body density measured by underwater weighing (UW-Db) : 1) r=0.881, SEE=0.00868/ml, 2) r=0.902, SEE=0.00788/nil for boys and 1) r= 0.741, SEE=0.0101 g/ml, 2) r=0.775, SEE =0.0095g/ml for girls. Furthermore, in a cross-validation analysis of prediction equations for Db, another sample consisting of 40 boys and 66 girls was used. Db estimated from each respective equation was correlated highly with UW-Db : 1) r=0.856, 2) r=0.887 for boys and 1) r=0.837, 2) r=0.860 for girls. There were no significant differences between the mean Db obtained by the BI method and that by the criterion method. We suggest that the prediction equations proposed in this study are useful for valid assessment of body composition of Japanese junior high school boys and girls aged 12 through 15 years.